AB0527 DIFFUSE ALVEOLAR HEMORRHAGE IN LATIN AMERICAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A CASE-CONTROL STUDY
Authors: D. C. Quintero-González, M. Muñoz-Urbano, J. Sanchez-Bautista, Y. Santamaria-Alza, A. Ramírez, C. Muñoz, A. L. Vanegas-García, G. Vásquez, L. A. González
Journal: Annals of the Rheumatic Diseases (2022)

Background Diffuse alveolar hemorrhage (DAH) is an uncommon and life-threatening complication of systemic lupus erythematosus (SLE) with a high mortality rate (estimated average 50%). The presence of respiratory symptoms (dyspnea, cough, hemoptysis), a new drop in hemoglobin levels, and diffuse infiltrates on chest imaging should raise suspicion of this complication. Objectives We aimed to describe DAH-SLE patients and compare them with non-DAH SLE patients. Methods We conducted a single-center, case-control study that enrolled hospitalized patients between 2012 and 2020 in Colombia. Twenty-three DAH-SLE patients (cases) were matched by age and sex with 23 non-DAH-SLE patients (controls). Descriptive, comparative, and logistic regression analyses were performed. Results In seven (30.4%) patients, DAH was the initial manifestation of SLE; 69.5% of DAH-SLE patients were females with a mean age of 35 years. Lupus nephritis was present in 65% of cases, mean hemoglobin decrease was 2.22 g/l [standard deviation (SD) 0.92 g/L], and 78% had hemosiderophages in bronchoalveolar lavage. All patients received intravenous (IV) pulses of methylprednisolone followed by high-dose steroids, 87.0% IV cyclophosphamide pulses, 60.8% plasmapheresis, 21.7% IV immunoglobulin, and 8.7% rituximab. Comparisons between DAH and non-DAH groups are shown in Table 1. Bivariate logistic regression analysis showed that male sex (OR 9.625 CI95% 1.07 - 86.17; p=0.043), higher SLEDAI-2K score (OR 1. 28 CI95% 1.10 - 1.48; p=0.001), and higher C-reactive protein (CRP) levels (OR 1.09 CI95% 1.01 - 1.18; p=0.016) were independently associated with the occurrence of DAH, whereas prior use of corticosteroids (OR 0.029 CI95% 0.003 - 0.25; p=0.001) and antimalarials (OR 0.121 CI95% 0.03 - 0.45; p=0.002), higher hemoglobin levels (OR 0.457 CI95% 0.29 - 0.71; p=0.001), higher C3 (OR 0.94 CI95% 0.91 - 0.97; p&lt;0.0001) and higher C4 levels (OR 0.87 CI95% 0.80 - 0.95; p=0.002) were negatively associated with DAH occurrence (Graph). Table 1. Demographic, clinical, serological, and therapeutic characteristics in DAH-SLE patients and non-DAH-SLE patients Variable Non-DHA SLE (n = 23) DHA SLE (n = 23) Female 95.6% 69.5% Age (years) 27.9 (SD 12.8) 34.82 (SD 17.3) Hospital stay (days)* 20.7 (SD 29.1) 34.39 (24.4) SLEDAI-2K* 6.17 (SD 5.9) 21.77 (12.5) Creatinine (mg/dL)* 2.5 (SD 3.7) 4.23 (SD 5.2) Leucocyte (cell/mm3) 8907 (5668) 9408 (5477) Neutrophil (cell/mm3) 7112 (5595) 8063 (5456) Lymphocyte (cell/mm3) 1236 (759) 952 (425) Hemoglobin (g/L) 10.5 (2.6) 6.9 (1.5) Ureic nitrogen (mg/dL)* 33.79 (SD 28.87) 45.73 (SD 25.64) ESR (mm/Hour) 51.5 (35.72) 64.65 (47.50) CPR (mg/dL)* 5.21 (SD 8.16) 12.42 (9.63) Ferritina (ng/mL) 509 (526) 891 (856) Lactate dehydrogenase (U/L)* 314 (SD 114) 503 (SD 357) C3 (mg/dL)* 84.8 (SD 23.07) 44.84 (SD 27.91) C4 (mg/dL)* 20.5 (10.3) 9.5 (8.2) Anti-dsDNA 42.8% 71.4% Anti-Ro 38.8% 38.8% Anti-La 11.1% 10.5% Anti-RNP 44.4% 47.3% Anti- Sm 38.8% 35% IgG ACL 0 9% IgM ACL 10.5% 13.6% Lupus anticoagulant 33.3% 33.33% Mucocutaneous involvement 78.2% 69.5% Articular involvement 73.9% 60.8% Hematological involvement 86.9% 69.5% Renal involvement 91.3% 86.9% Serosal involvement 34.7% 26.1% Prior glucocorticoid* 95.6% 39.1% Prior antimalarial* 69.5% 21.7% Dead 4.3% 21.7% *P value &lt; 0.05 Conclusion In about one-third of patients diagnosed with DAH, this life-threatening complication was the initial presentation of SLE. Male sex, higher SLEDAI-2K scores, and higher CRP levels were associated with DAH occurrence, whereas higher hemoglobin levels, elevated complement levels, prior use of glucocorticoids, and antimalarial treatment were negatively associated with the occurrence of DAH. Figure 1. Forest plot of factors associated with DHA-SLE patients. * *The Forest plot graph does not include the male sex variable due to its wide confidence intervals. Disclosure of Interests None declared